{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:03:13Z","timestamp":1756425793819,"version":"3.44.0"},"reference-count":19,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,1,3]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>A patient in her 50s presented with altered mental status and shortness of breath at 4600 m elevation. After descent to the base of the mountain, the patient became comatose. She was found to have bilateral pulmonary infiltrates and a serum sodium of 102 mEq\/L. She was rapidly corrected to 131 mEq\/L in 1\u2009day. Initial MRI showed intensities in bilateral hippocampi, temporal cortex and insula. A repeat MRI 17 days post injury showed worsened intensities in the bilateral occipital lobes. On admission to acute rehabilitation, the patient presented with blindness, agitation, hallucinations and an inability to follow commands. Midway through her rehabilitation course, antioxidant supplementations were started with significant improvement in function. Rapid correction of hyponatraemia may cause central pontine myelinolysis or extrapontine myelinolysis (EPM). In some cases of hypoxic brain injury, delayed post-hypoxic leucoencephalopathy (DPHL) may occur. Treatment options for both disorders are generally supportive. This report represents the only documented interdisciplinary approach to treatment of a patient with DPHL and EPM. Antioxidant supplementation may be beneficial as a treatment option for both EPM and DPHL.<\/jats:p>","DOI":"10.1136\/bcr-2023-255794","type":"journal-article","created":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T19:45:18Z","timestamp":1705607118000},"page":"e255794","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Rehabilitation after Hypoxic and Metabolic Brain Injury in a Mountain Climber"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4270-3804","authenticated-orcid":false,"given":"Henry Han","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Burke Rehabilitation Hospital, White Plains, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charnette","family":"Lercara","sequence":"additional","affiliation":[{"name":"NYU Langone Hospital Brooklyn, Brooklyn, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Burke Rehabilitation Hospital, White Plains, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Bushi","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Burke Rehabilitation Hospital, White Plains, New York, USA"},{"name":"Montefiore Health System, Bronx, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,1,18]]},"reference":[{"key":"2025082800574516000_17.1.e255794.1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2004.045906"},{"key":"2025082800574516000_17.1.e255794.2","first-page":"65","article-title":"The syndrome of delayed post-hypoxic leukoencephalopathy","volume":"26","author":"Shprecher","year":"2010","journal-title":"Neuro Rehab"},{"key":"2025082800574516000_17.1.e255794.3","article-title":"Delayed post-hypoxic leukoencephalopathy: a case series and review of the literature","volume":"10","author":"Katyal","year":"2018","journal-title":"Cureus"},{"key":"2025082800574516000_17.1.e255794.4","doi-asserted-by":"publisher","DOI":"10.1089\/152702904322963717"},{"key":"2025082800574516000_17.1.e255794.5","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2002.17.6.861"},{"key":"2025082800574516000_17.1.e255794.6","doi-asserted-by":"publisher","DOI":"10.1378\/chest.07-0561"},{"key":"2025082800574516000_17.1.e255794.7","unstructured":"Jacob D , Andrew L , et al . 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Delayed osmotic Demyelination Syndrome- an evolving spectrum; 2022."},{"key":"2025082800574516000_17.1.e255794.13","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1159\/000441892","article-title":"Delayed posthypoxic leukoencephalopathy: improvement with antioxidant therapy","volume":"7","author":"King","year":"2015","journal-title":"Case Rep Neurol"},{"key":"2025082800574516000_17.1.e255794.14","first-page":"505","article-title":"Acute altitude illness: updated prevention and treatment guidelines from the wilderness medical society","volume":"101","author":"Armstrong","year":"2020","journal-title":"Am Fam Physician"},{"key":"2025082800574516000_17.1.e255794.15","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.2005.031195"},{"key":"2025082800574516000_17.1.e255794.16","first-page":"600","article-title":"Central pontine myelinosis and osmotic demyelination syndrome","volume":"116","author":"Lambeck","year":"2019","journal-title":"Dtsch Arztebl Int"},{"key":"2025082800574516000_17.1.e255794.17","doi-asserted-by":"publisher","DOI":"10.1080\/02699050410001720130"},{"key":"2025082800574516000_17.1.e255794.18","doi-asserted-by":"crossref","first-page":"215","DOI":"10.32598\/irj.19.2.1327.1","article-title":"A stepwise multidisciplinary rehabilitation approach of central pontine and extra pontine myelinosis in locked-in syndrome: a case report","volume":"19","author":"Mohamad Hashim","year":"2021","journal-title":"IRJ"},{"key":"2025082800574516000_17.1.e255794.19","doi-asserted-by":"crossref","DOI":"10.3390\/antiox10121886","article-title":"Oxidative stress in the brain: basic concepts and treatment strategies in stroke","volume":"10","author":"Jelinek","year":"2021","journal-title":"Antioxidants (Basel)"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-255794","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:57:54Z","timestamp":1756367874000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-255794"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,18]]},"published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1136\/bcr-2023-255794"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-255794","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2024,1]]}}}